Provider Demographics
NPI:1891559100
Name:ROSS-PATTON, CRYSTAL M (APRN-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:ROSS-PATTON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1777
Mailing Address - Country:US
Mailing Address - Phone:580-371-5505
Mailing Address - Fax:
Practice Address - Street 1:63 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1777
Practice Address - Country:US
Practice Address - Phone:580-371-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily